A Medical View - P L May MBBS FRCS, Consultant Paediatric Neurosurgeon and member of ASBAH's Medical Advisory Committee.
Products Containing Latex
Foods with a Cross-Reactivity to Latex
Makers of Latex-Free Products
Severe reactions in patients exposed to the latex antigen was first described in 1984. Over the last few years, however, there has been an increasing recognition in the United States of the condition particularly with respect to patients with spina bifida and associated abnormalities. The Food and Drugs Administration (FDA) in the United States has undertaken several studies to examine the incidence of reaction in spina bifida patients to latex either in the form of skin rashes or more serious manifestations of sensitivity. In 1991 this incidence was reported to the FDA to be somewhere between 18-40%. It was noted by the American workers that children appeared to be particularly at risk of hypersensitivity with this allergen.
The Medical Devices Agency in the United Kingdom has been monitoring the subject of latex allergy for several years because of concerns raised by American reports of increased incidents of latex allergy among healthcare workers and certain groups of patients. At the present time there are no authoritative statistics which indicate the extent of the problems in the UK healthcare setting or in the general population. From our own experience in the Royal Liverpool Children's Hospital over the last six months we have documented at least one episode of a major hypersensitivity reaction in a young female patient with spina bifida undergoing corrective spinal surgery. The condition was recognised and she has made a full recovery.
The increased incidence of this sensitivity is thought to be related to the general increase in the use of latex products, particularly gloves, by healthcare workers and also to the incorporation of tube products with a higher latex content. Patients with neural tube defects and congenital urogenital abnormalities seem to be particularly at risk probably because of the increased number of surgical procedures they are exposed to involving equipment containing latex. Latex is present in many different types of material within the operating theatre set-up including surgical gloves, urinary catheters, surgical drains, disposable syringes and IV fluid giving sets.
Latex itself is a cloudy white liquid which comes from a rubber tree, Hevae brasiliensis. Once the liquid has been tapped from the tree, chemicals are added to it which provide the strength, elasticity and dimensional stability characteristic of many rubber products. Natural rubber latex is therefore composed of proteins and added chemicals, some of which would be removed during the later stages of production. The reactions that can occur in an allergic response to latex can range from mild irritation of the skin to more serious general manifestations of anaphylaxis or major shock.
In this country it is clear that more work needs to be done to identify the potential problem so that we can reassure our service users involved in repeated forms of surgery. This also involves increasing awareness among healthcare professionals as well as those service users susceptible to latex hypersensitivity. There are at present tests which are freely available to assess the sensitivity of the individual to latex, the commonest of which, I believe, is the RAST test which is a blood test. It is also possible to perform skin testing to latex allergy.
It is clear that more work needs to be done before we are able, in this country, to give a clearer picture of the true incidence of this apparently relatively rare event in service users undergoing frequent surgical procedures in the UK.
Latex is the sap from the Hevea brasiliensis tree. Common household and hospital products containing latex:
Household gloves
Hospital gloves
Condoms
Condom incontinence aids
Wheelchair tyres
Adhesive tapes (sticky plasters)
Some urinary catheters
Some enema tubing
Protective sheets
Colostomy/urostomy products
Balloons and rubber balls
Art supplies
Dental dams
Baby bottle nipples and pacifiers
Elastic on clothes
Beach toys
Chewing gum
There are alternative, non-latex products for all of these items. Usually, these alternatives are made of plastic, vinyl or silicone.
Research has shown that proteins found in certain foods show similar immune system reactivity to the proteins found in latex. So, if your mouth itches when you eat any of the foods listed below, you could be allergic to latex as well.
Foods which have been identified as having cross reactivity include:
Bananas
Potatoes
Avocados
Tomatoes
Kiwi Fruit
Mangoes
Chestnuts
Continence sheath - Clear Advantage from Depuy Healthcare. Freephone 0800-590916.
Disposable gloves - N-dex Nitrile EMS gloves from Sentinel Laboratories Ltd,12-13 Lindfield Enterprise Park, Lewes Rd, Lindfield, West Sussex RH16 2NH. Tel: (01444) 484044. Contact: Brian Smith.
